Noninvasive Staging of Non-small Cell Lung Cancer

Silvestri, Gerard A.; Gould, Michael K.; Margolis, Mitchell L.; Tanoue, L.T.; McCrory, Douglas C; Toloza, Eric M.; Detterbeck, Frank C.

doi:10.1378/chest.07-1360

Cited by 608 publications

(187 citation statements)

References 166 publications

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“…1 Currently, the most important prognostic factor for localized lung cancer is metastatic involvement of the mediastinal and hilar lymph nodes. 2 Transthoracic percutaneous needle biopsy (PNB) is routinely used to diagnose parenchymal [3][4][5][6][7] and accessible mediastinal [8][9][10][11][12][13] neoplasms.…”

mentioning

confidence: 99%

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Avritscher

Krishnamurthy

Ensor

et al. 2010

Cancer

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BACKGROUND: Because of their proximity to the pulmonary artery or vein, hilar lymph nodes are routinely biopsied with endobronchial or endoscopic ultrasonography (EUS)-guided fine-needle aspiration biopsy (FNAB). Computed tomography (CT)-guided percutaneous needle biopsy (PNB) allows the operator to acquire a larger core needle biopsy (CNB) when initial samples are inconclusive, when the suspected disease is not optimally diagnosed with FNAB, or when biomarkers are required. The purpose of this study was to retrospectively evaluate the sensitivity and accuracy of CT-guided PNB in patients with hilar adenopathy. METHODS: The authors identified 80 patients who underwent 81 CT-guided PNBs of pulmonary hilar lesions from October 2002 through December 2006 and retrospectively reviewed their medical and imaging records. The PNB sensitivity and accuracy were calculated in each case, and each case was reviewed for complications, including pneumothorax and subsequent thoracostomy tube insertion. RESULTS: PNB included FNAB and CNB in 81 (100%) and 14 (17%) procedures, respectively. Data on 69 PNB specimens (67 FNAB specimens and 13 CNB specimens) were available for statistical analysis. Overall, PNB had a sensitivity of 91.4% (95% confidence interval [CI], 81.0%-97.1%) and an accuracy rate of 92.8% (95% CI, 83.9%-97.1%). Pneumothoraxes occurred in 39 patients (48%), 26 (32%) of whom required thoracostomy tube insertion. CONCLU-SIONS: CT-guided PNB of pulmonary hilar lesions has high sensitivity and accuracy and represents a viable alternative for endobronchial ultrasound-or EUS-guided FNAB when larger biopsy samples are required for diagnosis or biomarker analysis. However, the procedure can result in high rates of pneumothorax.

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confidence: 99%

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Avritscher

Krishnamurthy

Ensor

et al. 2010

Cancer

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“…ACCP guidelines do not recommend 18 F-FDG PET-CT for surveillance at this time (34). Conversely, recent studies have demonstrated that asymptomatic patients with recurrences detected by intensive surveillance had a better prognosis than symptomatic patients (35).…”

Section: Follow-up Strategiesmentioning

confidence: 96%

Non-small cell lung cancer after surgery and chemoradiotherapy: follow-up and response assessment

Colombi¹,

Lauro²,

Silva³

et al. 2013

Diagn Interv Radiol

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The imaging techniques in patients treated for lung cancer may be challenging to interpret. Radiologists are often asked to evaluate computed tomography (CT) scans after surgery, and this interpretation requires an understanding of both the timing and type of the surgical procedure. However, follow-up strategies are still not well defined. The assessment of tumor response to chemoradiotherapy relies on a tight integration of CT and clinical findings. Positron emission tomography-computed tomography (PET-CT) with fluorodeoxyglucose may help to exclude tumor recurrence when the sole CT scan is equivocal. More efforts are needed to validate the tools for volumetric tumor measurement in routine practice and to demonstrate their superiority compared to the Response Evaluation Criteria in Solid Tumors (RECIST). Familiarity with the assessment of lung cancer perfusion is also important because of the increasing use of cytostatic therapy. In this review, we outlined the imaging assessment of tumor recurrence after surgery and the role of CT, magnetic resonance imaging, and PET-CT in the follow-up after chemotherapy, radiotherapy, and radiofrequency ablation.

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“…The PLUS multi-center randomized trial also proved the effectiveness of PET scan in preoperative patients with suspected lung cancer (4). Subsequently, Birm Ö et al (5) reported the same results in a meta-analysis and, recently, it has been indicated that PET scan should be undertaken for patients with lung cancer with regard to mediastinal and extrathoracic staging, and it is recommended as grade IB by a standardized method 'Methodology for Lung Cancer Evidence Review and Guideline Development' in the ACCP guidelines (6). Since PET/CT scan was introduced in our facility in December 2005, we have used it for lung cancer patients to diagnose preoperative staging, recurrence, and to judge the effectiveness of induction therapy.…”

Section: Introductionmentioning

confidence: 91%

Diagnosis of the presence of lymph node metastasis and decision of operative indication using fluorodeoxyglucose-positron emission tomography and computed tomography in patients with primary lung cancer

et al. 2010

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: Objectives : We evaluate whether integrated fluorodeoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT) scan can diagnose the presence of lymph node metastasis more accurately than computed tomography (CT) scan alone. Methods : Forty-two patients with lung cancer preoperatively underwent integrated PET/CT scan using FDG and CT scan and underwent pulmonary resection and lymph node dissection. We judged cases as lymph node metastasis if the lymph node visually accumulated FDG at PET/CT scan and measured 1 cm or greater in the short axis at CT scan. We retrospectively analyzed whether our judgments in each modality were consistent with the pathological diagnosis. Results : Two-hundred and seventeen stations of lymph node were dissected and 21 stations (9.7% %) were histologically diagnosed as positive metastasis. Thirty-two stations of lymph node visually accumulated FDG at PET/CT scan and 17 stations measured 1 cm or greater in the short axis at CT scan. Concerning the diagnosis of lymph node metastasis, PET/CT scan showed significantly higher sensitivity than CT scan (81% % vs. 48% %, p=0.024). The false-positive rate was significantly high in PET-positive lymph nodes measuring less than 1 cm in diameter. There were 4 falsenegative lymph nodes with both scans. All of these were less than 7 mm in diameter and had a low percentage of metastatic foci in the lymph node. Concerning the diagnosis of N staging, there was no significant difference between PET/CT scan and CT scan (83% vs. 69% %, p=0.124). However, the identification of N2 disease at PET/CT scan was significantly more accurate than that at CT scan (100% % vs. 38% %, p=0.031). Conclusions : PET/CT is superior to CT scan in lymph node staging. However, because the false-positive rate is high in PET-positive lymph nodes measuring less than 1 cm in diameter, we think that clinical background should be considered and other modalities or histological examinations should be undertaken if necessary. J. Med. Invest. 57 : 305-313, August, 2010

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Noninvasive Staging of Non-small Cell Lung Cancer

Cited by 608 publications

References 166 publications

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Accuracy and sensitivity of computed tomography‐guided percutaneous needle biopsy of pulmonary hilar lymph nodes

Non-small cell lung cancer after surgery and chemoradiotherapy: follow-up and response assessment

Diagnosis of the presence of lymph node metastasis and decision of operative indication using fluorodeoxyglucose-positron emission tomography and computed tomography in patients with primary lung cancer

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